Health News Florida’s Daylina Miller spoke recently with Mitch Zeller, the director of the Food and Drug Administration’s Center for Tobacco Products, about plans to prioritize enforcement against e-cigarettes that appeal to kids.

How does Florida compare with other states in the youth vaping epidemic? And how well have lawmakers responded?

We don’t have statewide data on kids’ use of e-cigarettes in Florida but we do have statewide data, and it’s a very good news story, on high school cigarette smoking rates in Florida.

For many years, Florida has been a leader when it comes to a cigarette prevention efforts and a number of national campaigns over the last 20 years have been modeled on successful prevention campaigns in Florida.

Florida has achieved a high school cigarette smoking rate that is below the current national average for cigarette smoking. And that’s great news. Nationally, we have an epidemic when it comes to kids’ use of e-cigarettes both in middle school and high school.

And that jeopardizes the great progress that’s been made in Florida and elsewhere when it comes to reducing kids’ smoking rates, because a kid that experiments with an e-cigarette is more likely to go on to try a cigarette.

The FDA has a new vaping enforcement policy to protect kids from e cigarettes. How does that relate to past and ongoing efforts, and how does it relate to the tobacco 21 law?

There’s really a comprehensive effort underway at the federal level to address this epidemic of kids’ use of e-cigarettes. And there are a number of components.

One is the president recently signed into law a bill that raises the federal minimum age of sale for any tobacco product, including e-cigarettes, to 21. That’s going to help.

FDA is doing compliance and enforcement activities and a massive public education campaign to get the word out to kids, to get information into the hands of parents and teachers and administrators.

We’re so concerned with what’s going on with kids in e-cigarettes because the research tells us that while kids are aware of how dangerous cigarette smoking is, too many kids are walking around thinking that e-cigarettes are basically harmless. They think that they’re just inhaling water vapor. Well, they’re not.

It’s an aerosol, it can contain high levels of nicotine, you risk becoming addicted to the nicotine in that aerosol. And there can be other harmful compounds as well from heavy metals to chemicals like acrolein that can cause lung damage.

It’s one thing if we’re talking to an addicted adult cigarette smoker who’s interested in switching away from cigarettes to a less harmful product compared to smoking. That’s irrelevant when it comes to kids. Kids should not be initiating on any of these products, even if it turns out that that an e-cigarette poses less risk than a cigarette.

Can you talk about the epidemic of lung disease diagnoses last year that was linked to black market vaping products?

Unfortunately, what unfolded last spring and summer was thousands of reported injuries, and unfortunately, dozens of deaths that were linked primarily to vaping products that were being used not to inhale nicotine, but to inhale THC.

And yes, a lot of this was black market because it is illegal to sell THC. So these weren’t being sold by legal manufacturers, distributors and retailers. A lot of these products were being sold off the street. And while people had been vaping THC prior to last spring and summer, the one thing that changed was somebody was diluting the THC oil with vitamin E acetate to make the THC go further.

And we think that had a lot to do with this spike in injuries and deaths that we previously hadn’t been seeing. As the lungs literally got coated with the oil from vitamin E acetate and the THC.

The good news is that reports of new injury have dramatically dropped off since we and the Centers for Disease Control got the word out starting this past summer. I think at the end of the day, there will not be one single cause of the injuries and deaths, but the overwhelming majority of the cases are linked to THC. And the overwhelming majority of the THC cases involve this vitamin E acetate oil.

Vaping’s been around for a while but we’ve only seen it become more popular in recent years. How much of that is related to these fruity-flavored pods and cartridges that tend to attract younger smokers?

We think that the popularity of the pod and cartridge flavored products play a very important role in the spike in kid’s use of e-cigarettes over the last two years.

People forget that in 2016 and 2017, we were seeing a decline and a leveling off in kid’s use of e-cigarettes and then everything changed two years ago. And one of the reasons why these pod or cartridge-based products are so popular is it’s not just the flavors – the fruit, the candy, the mint flavor – but they are very easy to use, and they are very easy to conceal.

Some of these products look exactly like flash drives, they literally get recharged by being plugged into laptops. There are kids that are using these products in classrooms. The bathroom has been a big place for kids to go Juul. Juul has become a verb.

And it’s these cartridges and pod-based products, easy to use, easy to conceal, very appealing flavors, and that’s the step that we’re taking today to get those products off the market. Coupled with our public education efforts, we hope that will reverse this this very disturbing trend.

Florida recently passed a law that banned vaping in certain indoor spaces. Do you feel those laws make a difference in cracking down on vaping?

FDA does not have the authority or the jurisdiction to enact those kinds of regulations. But states and localities absolutely are free to do that.

I can tell you that when we look back historically at what we call comprehensive tobacco control efforts at the state and local level, when it comes to reducing both adults and kids use of cigarettes, it’s not a one size fits all approach. There has to be public education, raising excise taxes at the state and local level have helped, and smoke free laws have helped over time.

It has helped to what we call de-normalize cigarette use, and it’s one of the reasons why we now have is starkly low rates of both adult and kids use of conventional cigarettes and we hope that that’s the direction that we are now headed with e-cigarettes.